scholarly journals Coronary Angiography-Derived Index of Microvascular Resistance

2020 ◽  
Vol 11 ◽  
Author(s):  
Hu Ai ◽  
Yundi Feng ◽  
Yanjun Gong ◽  
Bo Zheng ◽  
Qinhua Jin ◽  
...  
Keyword(s):  
Coronary Angiography ◽  
Predictive Value ◽  
Area Under The Curve ◽  
Aortic Pressure ◽  
Receiver Operating Curve ◽  
Cutoff Value ◽  
Pressure Wire ◽  
Physiological Assessment ◽  
Index Of Microvascular Resistance ◽  
Microvascular Resistance

A coronary angiography-derived index of microvascular resistance (caIMR) is proposed for physiological assessment of microvasular diseases in coronary circulation. The aim of the study is to assess diagnostic performance of caIMR, using wire-derived index of microvascular resistance (IMR) as the reference standard. IMR was demonstrated in 56 patients (57 vessels) with stable/unstable angina pectoris and no obstructive coronary arteries in three centers using the Certus pressure wire. Based on the aortic pressure wave and coronary angiograms from two projections, the caIMR was computed and assessed in blinded fashion against the IMR at an independent core laboratory. Diagnostic accuracy, sensitivity, specificity, positive predictive value and negative predictive value of the caIMR with a cutoff value of 25 were 84.2% (95% CI: 72.1% to 92.5%), 86.1% (95% CI: 70.5% to 95.3%), 81.0% (95% CI: 58.1% to 94.6%), 88.6% (95% CI: 76.1% to 95.0%), and 77.3% (95% CI: 59.5% to 88.7%) against the IMR with a cutoff value of 25. The receiver-operating curve had area under the curve of 0.919 and the correlation coefficient equaled to 0.746 between caIMR and wire-derived IMR. Hence, caIMR could eliminate the need of a pressure wire, reduce technical error, and potentially increase adoption of physiological assessment of microvascular diseases in patients with ischemic heart disease.

Evaluation of the Clinical Role of Strain Elastography in Patients Diagnosed With Congenital Torticollis

2021 ◽  
pp. 875647932098324
Author(s):  
Elif Özyazici Özkan ◽  
Mehmet Burak Ozkan ◽  
İshak Abdurrahman İsik
Keyword(s):  
Area Under The Curve ◽  
Muscle Group ◽  
Receiver Operating Curve ◽  
Control Group ◽  
Clinical Role ◽  
Congenital Muscular Torticollis ◽  
Cutoff Value ◽  
Strain Elastography ◽  
Specificity And Sensitivity ◽  
Muscular Torticollis

Objective: The objective of this study was to determine the elasticity of sternocleidomastoid muscle (SCM) in patients with congenital muscular torticollis (CMT). Methods: In all, 41 patients and 22 controls were included in the study, and the elasticity of the patients’ SCM was measured. Echogenicity, thickness, and strain values of the SCM were also obtained. Results: The thickness and strain values of the SCM were higher in the patient group than in the control group ( P = .02 and P = .15). For median values, there was no difference in echogenicity and strain. In the strain elastography evaluation of the receiver operating curve (ROC) for muscle echogenicity in the isoechoic muscle group, the specificity and sensitivity were determined to be 100% and 22%, respectively, for the area under the curve (AOC) value of 0.558 (95% confidence interval [CI], 0.424–0.6686), and the cutoff value was <1.4. In the hyperechoic muscle group, the ROC for AUC values was found to be 0.542 (95% CI, 0.411–0.6686), and the cutoff value was >1.4 with 100% sensitivity and 20.75 specificity. Conclusions: The strain elastography technique can be used in the diagnosis of CMT.

P6472Novel cardiac imaging prognostic markers of clinical outcome in patients with bicuspid aortic valve and chronic aortic regurgitation

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
R Kockova ◽  
H Linkova ◽  
Z Hlubocka ◽  
A Praveckova ◽  
A Polednova ◽  
...  
Keyword(s):  
Heart Failure ◽  
Surgical Treatment ◽  
Disease Progression ◽  
Predictive Value ◽  
Area Under The Curve ◽  
Early Disease ◽  
Regurgitant Fraction ◽  
Cutoff Value ◽  
Vena Contracta ◽  
Chronic Aortic Regurgitation

Abstract Background Patients with chronic aortic regurgitation (AR) can have a substantial myocardial damage despite being asymptomatic. Early surgical strategy might be beneficial. Bicuspid aortic valve (BAV) is a congenital heart disease present in almost 30% of these patients. Purpose Identify novel imaging predictors of early disease progression. Methods Prospective three-centre study of patients with chronic AR of at least moderate to severe (3+) grade and BAV morphology. Patients without currently recognised indication for surgical treatment were enrolled. Baseline examination included echocardiography (ECHO) with 3-dimensional (3D) vena contracta area and magnetic resonance (MR) with regurgitant fraction measured from flow sequence. All imaging studies were analysed in CoreLab. The primary endpoint was defined as a combination of cardiovascular death, surgical treatment or hospitalization for heart failure. Results A total of 83 patients with BAV and at least 3+ AR were enrolled during 2015–2018. Median follow-up was 759±455 days, primary composite endpoint occurred in 13 patients who met criteria for surgical treatment, no patient died or was hospitalized for heart failure. Baseline parameters were compared between two groups: patients with and without endpoint. Clinical and laboratory data did not differ between the two groups. Left ventricular (LV) ejection fraction was normal in all patients. LV diameters and volumes were significantly larger in patients with primary endpoint. This was most pronounced in MR measured indexed volumes in end-diastole and end-systole, P=0.003 and P=0.003. Non-invasive markers of diffuse myocardial fibrosis (native T1 relaxation time and global longitudinal strain, P=0.614 and P=0.137 respectively) were not different. Novel markers of AR severity were significantly increased in surgically treated patients: 3D vena contracta 0.26±0.10 cm2 versus 0.38±0.11 cm2 (P<0.001), MR regurgitant fraction 33.9±15.4 versus 50.2±12.2% (P=0.001). Both 3D vena contracta with cutoff value ≥0.4 cm2 (sensitivity=85%, specificity=84%, area under the curve=0.85) and MR regurgitant fraction with cutoff value ≥34% (sensitivity=94%, specificity=58%, area under the curve=0.76) showed high accuracy to identify patients who require early surgical intervention. Adding 3D vena contracta and MR regurgitant fraction to indexed LV end-systolic volumetric parameters significantly increases the predictive value for early disease progression with p=0.001 and p=0.006 (Likelihood-ratio test). 3D vena contracta predictive value Conclusions Novel imaging parameters of AR severity such as 3D vena contracta and MR derived regurgitant fraction predict early disease progression in patients with BAV and at least 3+ chronic AR. These values significantly increase the predictive value of traditional parameters based on LV size measures.

PLATELET COUNT AND SPLEEN DIAMETER RATIO FOR NON INVASIVE DIAGNOSIS OF ESOPHAGEAL VARICES

2021 ◽  
pp. 14-18
Author(s):  
Pooja Krishnappa ◽  
Vasant PK ◽  
Subhash Chandra
Keyword(s):  
Platelet Count ◽  
Roc Curve ◽  
Esophageal Varices ◽  
Predictive Value ◽  
Area Under The Curve ◽  
Meld Score ◽  
Diameter Ratio ◽  
P Value ◽  
Cutoff Value ◽  
Non Invasive

BACKGROUND: Portal Hypertension and its consequences mainly, Esophageal Varies (EVs) is one of the most important causes of morbidity and mortality in patients with cirrhosis of liver. Upper GI endoscopy is the investigation of choice for diagnosis of EVs and periodic endoscopies have been recommended for monitoring of varices. There is a need for non-invasive parameters to detect the presence of EVs. Identication of noninvasive predictors of EVs will help us to carry out EGD in selected groups of patients. Unnecessary endoscopies can be avoided and at the same time, patients who require endoscopy can be referred to a higher center, where facilities for endoscopy are available. Among the non-invasive modalities, the platelet count and bipolar spleen diameter ratio has shown promising results in terms of its accuracy in predicting the presence of Esophageal Varices in many studies MATERIALS AND METHODS: Patients with chronic liver disease diagnosed using clinical, Laboratory and ultrasound parameters were assessed using esophagogastroduodenoscopy for the presence or absence of esophageal varices. USG abdomen was done to assess for bipolar splenic diameter and the presence or absence of EV's was correlated with the platelet count/ splenic diameter ratio, CHILD SCORE, MELD score, Platelet count alone and splenic diameter alone. Platelet count/SD ratio of 909 based on previous studies was correlated with the presence or absence of varices. Statistical analysis was done using IBM SPSS software version 20.0 and variables showing statistically signicant correlations with presence of arices were used for plotting ROC curves to assess the cut of points which could be used for non invasive prediction of varices. RESULTS: The PC/SD ratio cut off (909), based on previous studies for non invasive diagnosis of Esophageal Varices gave sensitivity and specicity of 97.9% and 91.7% respectively, in our study, which was statistically signicant (P value <0.001). The positive predicitive value and negative predictive value of the PC/SD ratio (909) was 96.5% and 94.8% respectively and the accuracy of the test was 96%. ROC curve for Platelet count and Splenic diameter ratio area under the curve is 97.8% with P value < 0.001 and cutoff value 895.02 with sensitivity 96.6% and specicity 96.5%. The Positive predictive value and negative predictive value of PC/SD ratio of 895 was found to be 98.6% and 91.8% respectively and the accuracy of the test 96.5%. ROC curve for Child score in our study, area under the curve 71% with a signicant P value < 0.001, and cut-off value obtained for Child score was 8.50 with sensitivity 64.8% and specicity 63.8 %. ROC curve for MELD score revealed area under the curve was 74.3% with P value as < 0.001, and the cut-off value was 15.5 with sensitivity 67.6 % and specicity 67.2%. ROC curve for Platelet count in our study, the area under the curve was 94.5% with P value as < 0.001, and the cut-off value was 108500 with sensitivity and specicity of 89.7% and 89.4% respectively. The ROC curve for Spleen diameter in our study revealed that the area under the curve was 86.8%% with P value as < 0.001, and the cutoff value was 121 with sensitivity and specicity of 78.9% and 81.0% respectively. CONCLUSION: Among the variables studied for non-invasive diagnosis of Esophageal varices, the Platelet count / Spleen diameter ratio had the best sensitivity and specicity for diagnosing EVs. In view of low sensitivities and specicities for the cut off values obtained for Child score, MELD score, platelet count and spleen diameter, these indices may not be useful as PC/SD ratio in the non-invasive prediction of EV's. The Platelet count / Splenic diameter ratio may be proposed as a safe parameter for diagnosing Esophageal Varices in Chronic Liver disease noninvasively, where resources are limited and endoscopy facilities are not available, to select the patients with probable Esophageal Varices who can be referred to higher centres

scholarly journals Significance of platelet indices as severity marker in nonthrombocytopenic preeclampsia cases

2019 ◽  
Vol 11 (03) ◽  
pp. 186-191
Author(s):  
Shilpa Gopal Reddy ◽  
Chinaiah Subramanyam Babu Rajendra Prasad
Keyword(s):  
Disease Progression ◽  
Roc Curve ◽  
Predictive Value ◽  
Area Under The Curve ◽  
Severe Preeclampsia ◽  
Roc Curve Analysis ◽  
Diagnostic Significance ◽  
Distribution Width ◽  
Cutoff Value ◽  
Binary Regression Analysis

Abstract CONTEXT: Preeclampsia is often asymptomatic, and hence, its detection depends on signs or investigations. The platelet (PLT) parameters, in cases of preeclampsia with normal PLT count, are seldom analyzed. Hence, this study was undertaken to study the PLT parameters in nonthrombocytopenic preeclampsia cases. AIM: The aim was to evaluate the use of PLT indices as severity markers in nonthrombocytopenic preeclampsia cases. SUBJECTS AND METHODS: This prospective study was done on 120 cases of severe preeclampsia, 115 cases of preeclampsia without severe features, and 203 normal pregnant women admitted in the obstetrics wards during the study period of 1 year. The PLT indices obtained by analyzing anticoagulated blood were recorded. STATISTICAL ANALYSIS USED: Analysis of variance test was used to see the significance of association. Receiver operating characteristic (ROC) curve and binary regression analysis was used to estimate the cutoff value and examine the predictive value of the PLT parameters in the disease progression of preeclampsia. RESULTS: Even in the absence of thrombocytopenia, mean platelet volume (MPV) and PLT distribution width were significantly higher in severe preeclampsia group (P < 0.001) and were also positively correlating with mean arterial pressure (r = 0.38 and 0.20, respectively). ROC curve analysis showed that MPV had the highest area under the curve of 0.78 (95% confidence interval [0.719‒0.842]). Cutoff value of >10.95 fl for MPV was found to have significant predictive value for disease progression in preeclampsia. CONCLUSIONS: Even in the absence of thrombocytopenia, PLT indices, especially MPV, have a good diagnostic significance in detecting severe preeclampsia. Further studies are required to evaluate their role as biomarkers in preeclampsia.

scholarly journals Positive predictive value of CT coronary angiography vs. CT fractional flow reserve in a real-world population

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
H Sinclair ◽  
R L Yongli ◽  
A Beattie ◽  
M Farag ◽  
M Egred
Keyword(s):  
Coronary Artery ◽  
Coronary Angiography ◽  
Positive Predictive Value ◽  
Real World ◽  
Predictive Value ◽  
Diagnostic Tools ◽  
Computerised Tomography ◽  
Fractional Flow ◽  
Flow Reserve ◽  
Pressure Wire

Abstract Background Computerised tomography coronary angiography and fractional flow reserve (CTCA and CT-FFR) are non-invasive diagnostic tools for the detection of flow limiting coronary artery stenoses. Although their negative predictive values are well established, there is a concern that the high sensitivity of these tests may lead to overestimation of coronary artery disease (CAD) and unnecessary invasive coronary angiography (ICA). We compared the positive predictive value (PPV) of CT-FFR with computerised tomography coronary angiography (CTCA) against the gold standard of ICA in different real-world patient groups. Methods We conducted a retrospective study of 477 patients referred for CTCA or CT-FFR for investigation of possible coronary ischaemia. Patients were excluded if the image quality was poor or inconclusive. Patient-based PPV was calculated to detect or rule out significant CAD, defined as more than 70% stenosis on ICA. A sub-analysis of PPV by indication for scan was also performed. Patients that underwent invasive non-hyperaemic pressure wire measurements had their iFR or RFR compared with their CT-FFR values. Results In a patient-based analysis, the overall PPV was 59.3% for CTCA and 76.2% for CT-FFR. This increased to 81.0% and 86.7% respectively for patients with stable angina symptoms. In patients with atypical angina symptoms, CT-FFR considerably outperformed CTCA with a PPV of 61.3% vs. 37.5%. There was not a linear relationship between invasive pressure wire measurement and CT-FFR value (r=0.23, p=0.265). Conclusion The PPV of CTCA and CT-FFR is lower in the real-world than in previously published trials, partly due to the heterogeneity of indication for the scan. However, in patients with typical angina symptoms, both are reliable diagnostic tools to determine the presence of clinically significant coronary stenoses. CT-FFR significantly outperforms CTCA in patients with more atypical symptoms and the targeted use of CT-FFR in this group may help to avoid unnecessary invasive procedures. FUNDunding Acknowledgement Type of funding sources: None.

scholarly journals Prediction of hospitalization using artificial intelligence for urgent patients in the emergency department

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Jung-Ting Lee ◽  
Chih-Chia Hsieh ◽  
Chih-Hao Lin ◽  
Yu-Jen Lin ◽  
Chung-Yao Kao
Keyword(s):  
Artificial Intelligence ◽  
Emergency Department ◽  
Hospital Admission ◽  
Subgroup Analysis ◽  
Predictive Value ◽  
Model Building ◽  
Area Under The Curve ◽  
Cutoff Value ◽  
Tertiary Teaching ◽  
Level 3

AbstractTimely assessment to accurately prioritize patients is crucial for emergency department (ED) management. Urgent (i.e., level-3, on a 5-level emergency severity index system) patients have become a challenge since under-triage and over-triage often occur. This study was aimed to develop a computational model by artificial intelligence (AI) methodologies to accurately predict urgent patient outcomes using data that are readily available in most ED triage systems. We retrospectively collected data from the ED of a tertiary teaching hospital between January 1, 2015 and December 31, 2019. Eleven variables were used for data analysis and prediction model building, including 1 response, 2 demographic, and 8 clinical variables. A model to predict hospital admission was developed using neural networks and machine learning methodologies. A total of 282,971 samples of urgent (level-3) visits were included in the analysis. Our model achieved a validation area under the curve (AUC) of 0.8004 (95% CI 0.7963–0.8045). The optimal cutoff value identified by Youden's index for determining hospital admission was 0.5517. Using this cutoff value, the sensitivity was 0.6721 (95% CI 0.6624–0.6818), and the specificity was 0.7814 (95% CI 0.7777–0.7851), with a positive predictive value of 0.3660 (95% CI 0.3586–0.3733) and a negative predictive value of 0.9270 (95% CI 0.9244–0.9295). Subgroup analysis revealed that this model performed better in the nontraumatic adult subgroup and achieved a validation AUC of 0.8166 (95% CI 0.8199–0.8212). Our AI model accurately assessed the need for hospitalization for urgent patients, which constituted nearly 70% of ED visits. This model demonstrates the potential for streamlining ED operations using a very limited number of variables that are readily available in most ED triage systems. Subgroup analysis is an important topic for future investigation.

Diagnostic performance of renal ultrasonography in detecting chronic kidney disease of various severity

2020 ◽  
Vol 14 (5) ◽  
pp. 195-202
Author(s):  
Iroshani Kodikara ◽  
Dhanusha T. K. Gamage ◽  
Ganananda Nanayakkara ◽  
Isurani Ilayperuma
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Predictive Value ◽  
Diagnostic Performance ◽  
Area Under The Curve ◽  
Receiver Operating Curve ◽  
Receiver Operating Curve Analysis ◽  
Complementary Role ◽  
Diagnostic Role ◽  
Estimated Glomerular Filtration Rates

AbstractBackgroundAssociation between early diagnosis of chronic kidney disease (CKD) and low morbidity and mortality rate has been proven. Thus, tools for early CKD diagnosis are vital. Ultrasonography has been widely used to diagnose and monitor the progression of CKD.ObjectivesTo determine the performance of selected renal ultrasonographic parameters for the diagnosis of early CKD.MethodsIn a cohort of patients diagnosed with CKD (n = 100), diagnostic performance of ultrasonographically measured renal length (RL), renal cortical thickness (RCT), and parenchymal thickness (PT) was determined using receiver operating curve analysis; correlation of each parameter with the associated comorbidities and serum creatinine (Scr) levels was also determined. Severity of CKD was graded with estimated glomerular filtration rates (eGFR).ResultsOf all patient participants, 85 had severity grades 2 or 3. Mean (standard deviation) Scr was 1.88 (0.60) mg/dL; eGFR was 43.3 (11.85) mL/min/1.73 m2. RL was 9.01 (0.83) cm, PT was 1.32 (0.22) cm, and RCT was 6.0 (0.10) mm. PT and RCT were positively correlated with eGFR (P = 0.01 and 0.002, respectively). Early CKD was better predicted by PT (area under the curve (AUC) 0.735; 82% sensitivity; 30% specificity; 68% positive predictive value (PPV)) and RCT (AUC 0.741; 82% sensitivity; 48% specificity; 51% PPV); severe CKD was better predicted by RL (AUC 0.809; 67% sensitivity; 26% specificity, 45% PPV; 13% negative predictive value).ConclusionIndex ultrasonic parameters show a diagnostic role in different stages of CKD. The index ultrasound and biochemical parameters showed a complementary role in predicting renal dysfunction.

The Ratio of Fibrinogen to Albumin as a Predictor of Contrast-Induced Nephropathy After Carotid Angiography

Angiology ◽  
2018 ◽  
Vol 70 (5) ◽  
pp. 458-464 ◽  
Author(s):  
Faruk Ertas ◽  
Eyup Avci ◽  
Tuncay Kiris
Keyword(s):  
Predictive Value ◽  
Area Under The Curve ◽  
Carotid Angiography ◽  
Contrast Induced Nephropathy ◽  
Albumin Ratio ◽  
Cutoff Value ◽  
Lymphocyte Ratio ◽  
Radiocontrast Agent ◽  
Independent Risk Factors ◽  
Sensitivity Specificity

Contrast-induced nephropathy (CIN) is acute kidney failure that occurs after exposure to contrast agent. There is no sensitive biomarker to predict the development of CIN. In a retrospective study, we investigated the predictive value of the fibrinogen to albumin ratio (FAR) to determine the risk of CIN in patients (N = 246) who underwent carotid angiography. Contrast-induced nephropathy was defined as a 0.5 mg/dL or 25% increase in serum creatinine levels 48 to 72 hours following exposure to a radiocontrast agent. Patients were grouped according to whether they developed CIN or not, that is, CIN(–) and CIN(+) groups, respectively. Contrast-induced nephropathy developed in 39 (15.8%) of all the patients. The fibrinogen levels, neutrophil to lymphocyte ratio (NLR), and FAR in the CIN (+) group were higher than in the CIN (−) group ( P < .001). Multivariate analysis showed that age, diabetes, NLR, platelet–lymphocyte ratio, and FAR were independent risk factors for CIN. The area under the curve (AUC) of FAR was 0.800 for the prediction of CIN, and the best cutoff value was 57.4 with sensitivity, specificity, positive predictive value, and negative predictive value of 74.4%, 60.8%, 26.4%, and 92.7%, respectively. The FAR may be useful as a predictor of CIN.

scholarly journals 1034. “Four-Leaf Clover Sign” as a Rapid Identification of Coagulase-Negative Staphylococci Species by Gram Stain of Blood Culture

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S308-S309
Author(s):  
Takahiro Matsuo ◽  
Kuniyoshi Hayashi ◽  
Nobuyoshi Mori
Keyword(s):  
Blood Culture ◽  
Predictive Value ◽  
Area Under The Curve ◽  
Morphological Characteristics ◽  
Predictive Ability ◽  
Receiver Operating Curve ◽  
Significant Variable ◽  
Gram Stain ◽  
Coagulase Negative Staphylococci ◽  
Mortality And Morbidity

Abstract Background Gram-positive coccus (GPC) in cluster bacteremia is associated with high mortality and morbidity. Although laboratory technologists note morphological characteristics such as the size and number of cells help distinguish S. aureus and Coagulase-negative staphylococci (CoNS), there are few studies that explored the optimal findings to distinguish between them by Gram stain. Here, we analyze some findings in Gram stain contributing to identify S. aureus or CNS. Methods This study was conducted at St. Luke`s International Hospital from November 2016 and September 2017. Broths for which a Gram stain showed GPC cluster were included in our study. Two infectious diseases fellows examined direct Gram stains of blood culture within 24 hours of positivity. We defined the sign as follows: four-leaf clover (FLC) sign if four GPCs gather like four-leaf clover (Figure 1) and three-dimensional (3D) sign if GPCs resemble big grapes. They counted the number of fields that have FLC and 3D signs out of 10 fields per each slide. We performed logistic regression analysis to assess whether these signs are the contributable factors to identify SA or CNS. The predictive ability of these signs was evaluated on the basis of the sensitivity (Sen), specificity (Spe), positive predictive value (PPV), and negative predictive value (NPV) for CoNS with receiver operating curve (ROC) analysis. Results In total, 106 blood cultures in which a direct Gram stain showed GPC in cluster were examined. Cultures revealed 46 (43%) were SA and 66 (57%) were CoNS. A multivariate logistic analysis showed that FLC sign was statistically significant variable of CoNS with odds ratio (OR) 1.20 (95% CI 1.09–1.35, P &lt; 0.05). In aerobic bottles, Sen, Spe, PPV, and NPV were 0.67, 0.91, 0.92, and 0.65, respectively (Table 1) and area under the curve (AUC) was 0.79 (95% CI 0.67–0.91) (Figure 2). Cut-off fields were 6.5 out of 20. Conclusion This is the first study to show FLC sign could be a rapid and useful finding of Gram stain to identify CoNS rather than SA in aerobic bottles. In the presence of FLC sign, clinicians should highly suspect of CoNS with PPV of 92% before the final identification. Disclosures All authors: No reported disclosures.

scholarly journals GLP-1 vasodilatation in humans with coronary artery disease is not adenosine mediated.

2020 ◽  
Author(s):  
Muhammad Aetesam-ur-Rahman ◽  
Joel P. Giblett ◽  
Bharat Khialani ◽  
Stephen Kyranis ◽  
Sophie J. Clarke ◽  
...  
Keyword(s):  
Flow Velocity ◽  
Coronary Intervention ◽  
Infusion Group ◽  
Pressure Wire ◽  
Percutaneous Coronary ◽  
Patients With Diabetes ◽  
Index Of Microvascular Resistance ◽  
Artery Disease ◽  
Incretin Therapies ◽  
Microvascular Resistance

Abstract Background Incretin therapies appear to provide cardioprotection and improve cardiovascular outcomes in patients with diabetes, but the mechanism of this effect remains elusive. We have previously shown that glucagon-like peptide (GLP)-1 is a coronary vasodilator and we sought to investigate if this is an adenosine-mediated effect.Methods We recruited 41 patients having percutaneous coronary intervention (PCI) for stable angina and allocated them into four groups administering a specific study-related infusion following successful PCI: GLP-1 infusion (Group G) (n = 10); Placebo, normal saline infusion (Group P) (n = 11); GLP-1 + Theophylline infusion (Group GT)(n = 10); and Theophylline infusion (Group T) (n = 10). A pressure wire assessment of coronary distal pressure and flow velocity (thermodilution transit time – Tmn) at rest and hyperaemia was performed after PCI and repeated following the study infusion to derive basal and index of microvascular resistance (BMR and IMR).Results There were no significant differences in the demographics of patients recruited to our study. Most of the patients were not diabetic. GLP-1 caused significant reduction of resting Tmn that was not attenuated by theophylline: mean delta Tmn (SD) group G -0.23 s (0.27) vs. group GT -0.18 s (0.37), p = 0.65. Theophylline alone (group T) did not significantly alter resting flow velocity compared to group GT: delta Tmn in group T 0.04 s (0.15), p = 0.30. The resulting decrease in BMR observed in group G persisted in group GT: -20.83 mmHg.s (24.54 vs. -21.20 mmHg.s (30.41), p = 0.97. GLP-1 did not increase circulating adenosine levels in group GT more than group T: delta median adenosine − 2.0 ng/ml (-117.1, 14.8) vs. -0.5 ng/ml (-19.6, 9.4); p = 0.60.Conclusion The vasodilatory effect of GLP-1 is not abolished by theophylline and GLP-1 does not increase adenosine levels, indicating an adenosine-independent mechanism of GLP-1 coronary vasodilatation..

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